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Biomaterials in TMJ replacement853Discussion: Future Directions for Temporomandibular Joint Materials Although indications for alloplastic TMJ TJR have been clearly outlined, and vast advancements in TMJ TJR systems have been made over the last couple of decades, it is clear that there is still room for improvement, especially with respect to biocompatibility and wear resistance of the currently used materials. As recent research by Onoriobe et al.(66) has indicated that the demand for use of TMJ TJR devices in the management of end-stage TMD will only further increase up until 2030, it is important that research into future generations of TMJ materials will address these shortcomings.As such, current research focusses on both the development of new materials, as well as surface modification strategies. Another important advance is undoubtedly the introduction of additive manufacturing, which allows the production of customized patient-fitted implants with tailored material characteristics. Furthermore, as in other fields, the implementation of tissue engineering approaches is gaining attention. The literature suggests that further development of TJR is currently at a crossroads between alloplastic design and tissue engineering. While tissue engineering has shown very promising results, more cost-effective 3 dimensional (3D)-printing and further developments in the field of biomaterials are showing promising results as well. Furthermore, tissue engineering is still far from being perfected; as such, it is not likely to be a reliable therapeutic solution in the immediate or near future.(33,67) Only advances in the field of biomaterials development are discussed below.Β-titanium alloysAs indicated earlier, although Ti alloys have proven to be highly corrosionresistant and biocompatible, there are growing concerns regarding longterm implantation because of the release of potentially toxic alloying elements, such as Al and V, and the risk of stress shielding, as their elastic modulus values are still relatively high compared to the elastic modulus of bone. These limitations have triggered the development of more biocompatible, low-modulus β-Ti alloys that contain non-toxic Nikolas de Meurechy NW.indd 85 05-06-2024 10:14